禽类养殖患者手术部位感染调查分析

Survey and analysis of surgical site infections in poultry farmers

目的分析禽类养殖创伤患者手术部位感染病原菌分布特点及其耐药性,提高临床对特定人群手术治疗水平,降低医院感染率,提示畜牧、医疗等相关部门对禽源性耐药菌的重视。方法选择2014年6月-2016年6月医院外科收治的17 073例各类创伤患者为研究对象,筛选出从事禽类养殖行业创伤患者共541例,回顾性分析患者手术部位感染率,对感染患者送检标本进行病原菌鉴定及药敏试验。结果 541例禽类养殖手术患者手术部位感染率为8.13%(44/541),高于综合职业患者手术部位感染率2.99%(494/16532),差异有统计学意义(χ2=45.44,P<0.001);44例感染患者共分离出病原菌83株,主要革兰阳性菌对青霉素G、左氧氟沙星、庆大霉素耐药率达100.00%,对呋喃妥因、万古霉素以及利奈唑胺敏感;主要革兰阴性菌中铜绿假单胞菌对庆大霉素、左氧氟沙星、头孢哌酮/舒巴坦耐药率达100.00%,大肠埃希菌对庆大霉素、左氧氟沙星、头孢哌酮/舒巴坦耐药率较高,铜绿假单胞菌,大肠埃希菌均对亚胺培南、呋喃妥因、美罗培南敏感。结论禽类养殖行业患者手术部位感染率明显高于其他人群手术部位感染率,患者长期暴露于防治禽病抗菌药物使用及禽便排泄污染的环境中,感染病原菌对常用抗菌药物耐药率较高。

OBJECTIVE To investigate the distribution and drug resistance of pathogens causing surgical site infections in poultry farmers so as to raise the level of surgical treatment of designated population,reduce the incidence of nosocomial infections and remind the relevant departments like rear livestock department and medical department to attach great importance to avian-derived resistant bacteria.METHODS A total of 17 073 patients with various traumas who were treated in the surgery department from Jun 2014 to Jun 2016 were recruited as the study objects,541 patients who engaged in poultry faming industry were screened out.The incidence of surgical site infection was retrospectively analyzed,the submitted specimens of the patients with infection were cultured,the isolated pathogens were identified,and the drug susceptibility testing was performed.RESULTS Of the 541 patients who engaged in the poultry farming industry,the incidence rate of surgical site infection was 8.13%（44/541）,significantly higher than 2.99%（494/16532）of the patients with comprehensive occupations（χ^2=45.44,P〈0.001）.Totally 83 strains of pathogens were isolated from 44 patients with the infection.The drug resistance rates of the main gram-positive bacteria to penicillin G,levofloxacin and gentamycin were as high as 100.00%,and the strains were susceptible to nitrofurantoin,vancomycin and linezolid.Among the gram-negative bacteria,the drug resistance rates of Pseudomonas aeruginosa strains to gentamycin,levofloxacin and cefoperazone-sulbactam were as high as 100.00%,the Escherichia coli strains were highly resistant to gentamycin,levofloxacin and cefoperazone-sulbactam;the P.aeruginosa and E.coli strains were susceptible to imipenem,nitrofurantoin and meropenem.CONCLUSIONThe incidence rate of surgical site infection of the poultry farmers is remarkably higher than that of other populations,they are exposed to the use of antibiotics for prevention and treatment of poultry diseases and contamination of poultry discharge.The pathogens causing the infection are highly resistant to the commonly used antibiotics.